First Visit

During your first visit to Semmes Murphey, our staff will ask you fill out a form that will provide the doctor with the necessary information they need about your age, history of family illnesses, and the symptoms that you are experiencing. Please be assured that any and all information you provide us with will be kept confidential. 


At Semmes Murphey, we encourage all patients to pre-register. Please be assured that this site is secure and that we take the protection of your confidential health information very seriously. By completing these forms ahead of time, your information can be prepared before you arrive for your appointment, and this will help us expedite your check-in process.

You have three options for pre-registering with us:

1. Pre-register Online

You may pre-register online by clicking the “Online Pre-Registration Form” link below. Please complete as much information as possible. If questions do not apply to you, type “N/A” in the appropriate fields. When you have completed this form, you may click the “submit” button at the end of this form, and your information will be forwarded to one of our pre-registration staff.

Register Online

2. Fax in Your Forms

You may print the forms by opening the attached PDF files. Complete the Patient Profile, Medical History and Miscellaneous forms and fax them to 901.522.7719. The PDF files for these forms are attached below.

3. Bring Forms to Your Appointment

You may print the Patient Profile, Medical History and Miscellaneous forms, fill them out and bring them with you to your appointment. The PDF files for these forms are attached below.

The following forms are in Adobe Acrobat format:

Registration / Patient Profile Form

Medical History Form

Benefit Assignment Form

Notice of Privacy Practices

Download Adobe Acrobat here.

Please review the following information:

  • Arrive 40 minutes early for your appointment.
  • Bring your current insurance card with you.
  • Remember to bring your referral and co-pay (if your insurance carrier requires it).
  • Bring all MRI and X-ray film and/or CDs that pertain to your current illness. Please also bring any records from your referring physician.
  • If you do not have insurance, be prepared to pay for your visit at the time of services.

Request an Appointment